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NUR 406
Spring 2017
Stephen F. Austin State University
DeWitt School of Nursing
NURSING CARE OF CLIENTS WITH COMPLEX HEALTH NEEDS
Course Number: NUR 406
Section Number: 001
Clinical Section(s): 010 - 016
Spring 2017
Course Instructors
Ms. Candace Carter, MSN, RN, FNP-C
Mrs. Laura Logan, MSN, RN Course Coordinator
Ms. Regina Low, MSN, RN
Mrs. Joy Shupak, MSN, RN
ALL INFORMATION IN THIS SYLLABUS IS SUBJECT TO THE WRITTEN
POLICIES AND PROCEDURES OF THE SCHOOL OF NURSING, STEPHEN F.
AUSTIN STATE UNIVERSITY NACOGDOCHES, TEXAS.
IN THE CASE OF COMMISSION, OMISSION, AMBIGUITY, VAGUENESS, OR
CONFLICT, THE POLICIES AND PROCEDURES OF THE SCHOOL OF NURSING
SHALL CONTROL.
EACH STUDENT SHALL BE RESPONSIBLE FOR ACTUAL AND/OR
CONSTRUCTIVE KNOWLEDGE OF THE POLICIES AND PROCEDURES OF THE
SCHOOL OF NURSING AND FOR COMPLIANCE THEREWITH.
EACH STUDENT IS RESPONSIBLE FOR ALL INFORMATION IN THIS SYLLABUS.
This syllabus is provided for informational purposes only.
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NUR 406
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Faculty Contact Information:
Name: Candace Carter, MSN, RN, FNP-C
Department: Nursing
Email: [email protected]
Office: Room 168
Phone: (936) 468-7715
Office Hours: Mon. 8-11; 3-5
Wed. 9-12
Name: Laura Logan, MSN, RN
Department: Nursing
Email: [email protected]
Office: Room 170
Phone: (936) 468-7723
Office Hours: Mon: 9-11
Tues: 9-12; 1-4
Name: Regina Low, MSN, RN
Department: Nursing
Email: [email protected]
Office: Room 180
Phone: (936) 468- 7724
Office Hours: Tues: 12-4
Fri: 12-4
Name: Joy Shupak, MSN, RN
Department: Nursing
Email: [email protected]
Office: Room 172
Phone: (936) 468-7735
Office Hours: Mon: 10-12; 3-4
Tues: 9-3:30
Please call in advance as times may vary due to committee obligations.
Class meeting times and places: Refer to Course Calendar for time and location.
TEXTBOOKS & SUPPLIES
Required Texts:
 All textbooks from prior nursing courses.
 Introduction to Critical Care Nursing, 7th edition (Sole, Klein, Moseley) Elsevier
 Clinical Skills Critical Care Collection, Elsevier (web based product) * should be
included in previously purchased Clinical Skills
 Elsevier Adaptive Quizzing for the NCLEX-RN Exam (36-Month), 2nd Edition
 Hemodynamic Monitoring Made Incredibly Visual 3rd edition, (Knapp) Lippincott
 2016 Intravenous Medications 32nd edition (Gahart) Elsevier
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
A Nurse’s Story Life, Death, and In-between in an intensive care unit. (Shalof)
SUGGESTED TEXTS:
 HESI Comprehensive Review for the NCLEX – RN Examination Edition 5 Elsevier.
 Patient Reviews by Elsevier (On-line). May be purchased from any of the bookstores on
or near the SFA campus. (You should already have this.)
Course Description
Six semester hours, three hours didactic and nine hours clinical practicum. This course provides
students the opportunity apply critical thinking, nursing theory, research and practice to acutely
ill clients of diverse spiritual, ethno-cultural and socioeconomic backgrounds in a variety of
clinical settings. Emphasis is placed on meeting needs of acutely ill clients and nurse’s role in
addressing legal, ethical and economic issues within the interdisciplinary health care team.
Unabridged Course Description
This course builds upon concepts learned in Nursing Care of Young Adults to Elderly, previous,
concurrent, and pre-requisite courses. This course provides students with the opportunity to
apply critical thinking, nursing theory, research, and practice to clients of diverse spiritual, ethno
cultural, and socioeconomic backgrounds. Students will utilize the nursing process with clients
experiencing acute/chronic complex health problems in a variety of clinical settings. Emphasis is
placed on the challenges if meeting the needs of the acutely ill clients and a holistic manner and
the nurse’s role in addressing associated legal, ethical, and economic issues in conjunction with
the interdisciplinary health care team.
Number of Credit Hours
6 semester hours (3 hours didactic; 9 hours clinical practicum)
Prerequisites and Co-requisites
Prerequisites: NUR 330, NUR 331, NUR 332
Co-requisites: NUR 407, NUR 408
Program Learning Outcomes
Graduates of the program will:
1. Apply knowledge of the physical, social, and behavioral sciences in the provision of nursing
care based on theory and evidence based practice.
2. Deliver nursing care within established legal and ethical parameters in collaboration with
clients and members of the interdisciplinary health care team.
3. Provide holistic nursing care to clients while respecting individual and cultural diversity.
4. Demonstrate effective leadership that fosters independent thinking, use of informatics, and
collaborative communication in the management of nursing care.
5. Assume responsibility and accountability for quality improvement and delivery of safe and
effective nursing care.
6. Serve as an advocate for clients and for the profession of nursing.
7. Demonstrate continuing competence, growth, and development in the profession of nursing
General Education Core Curriculum Objectives/Outcomes
None
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Student Learning Outcomes
The student will:
1. Relate concepts and principles of the arts, sciences, humanities, and nursing as a source for
making nursing practice decisions with clients and families experiencing complex heath stressors
2. Demonstrate responsibility and accountability using consistent behavior patterns and
professional communication.
3. Evaluate research for applicability of findings to the provision of nursing care.
4. Incorporate the nursing process as a template to formulate and implement individualized plans
of care for clients with complex health needs.
5. Utilize advanced assessment and critical thinking skills to provide comprehensive nursing care
in teaching clients and families experiencing complex health stressors.
6. Incorporate moral, ethical, economic, and legal issues in the provision of nursing care to
clients and families.
7. Collaborate with the interdisciplinary healthcare team members respecting holistic, socioeconomic, spiritual, and ethno-culturally diverse characteristics of clients and families
experiencing complex health stressors.
Differentiated Essential Competencies (DEC’s)
The Richard and Lucille DeWitt School of Nursing prepares graduates to demonstrate the
Differentiated Essential Competencies of Graduates of Texas Nursing Programs Evidenced by
Knowledge, Clinical Judgments, and Behaviors (DECs). The competencies are based upon the
preparation in the program of study. In nursing education, the DEC’s serve as a guideline and
tool for curriculum development and revision, a tool for benchmarking and evaluation of the
program, and statewide standard to ensure graduates will enter practice as safe and competent
nurses. The DECs are incorporated into every course in the SON to ensure uniformity and
continuity of standards.
Please refer to the Texas BON website for additional information:
https://www.bon.texas.gov/pdfs/differentiated_essential_competencies-2010.pdf
Course Requirements
 4 course exams
 2 HESI Exams
 Quizzes (including A Nurse’s Story Assignment)

NCLEX questions (Adaptive Quizzing)
 Weekly clinical work
 Evolve Critical Care Skills Videos
See Below for more information
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NUR 406
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Nursing 406
Nursing Care of Clients with Complex Health Needs
Tentative Course Calendar
Spring 2017
Date
Time
Chapter
1/17
Rm 101
8-12
1,2,9,15
Title
Overview of Course; intro to CC roles &
standards; patient/family teaching
Pulmonary part 1
ABGs, Vents, chest tubes, oxygen delivery
devices
EKG interpretation: Sinus rhythms
Instructor
All
Carter
Carter/Shupak
Rm 101
1-5
LL;9, 15
1/18
Rm 101
8-12
LL; 7
1-4
13
1/23
Rm 101
12-3
9,15
1/25
Rm 101
8-5
COC 1
(All)
5
Pain, Sedation, Delirium
Drugs/Calculations, Critical Care Meds
Concept Mapping
Critical Care Assessment/Documentation
Hospital Expectations/Orientation
All
1/26
All
LL
All
1/30
Rm 115
8-10
Exam 1
Simulation Lab-Documentation Sim
See additional schedule for assigned time
Pain, sedation, delirium, CC roles, med
calculations, medications, EKG, All
pulmonary (includes LL) & Cardiac Day 1
1/30
Rm 101
12-4
LL
1/31
G
2/1
Shupak
Cardiac Day 1
Logan
Pulmonary part 2
Carter
All
Atrial and Ventricular Rhythms, Blocks,
Junctional rhythms
Shupak
Clinical Day
Respective Hospital Clinical
Carter
EFH
Clinical Day
Respective Hospital Clinical
2/2
EH
Clinical Day
Respective Hospital Clinical
Logan, Shupak,
Low
Logan, Low
2/6
Rm 101
12-3
14
2/7
C
2/8
ABD
Neuro: Strokes, ICP patho and
therapeutic interventions, ICP
monitoring, coma, craniotomy,
hematomas
Carter
Clinical Day
Respective Hospital Clinical
Carter
Clinical Day
Respective Hospital Clinical
Logan, Shupak,
Low
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NUR 406
Spring 2017
2/9
AD
Clinical Day
2/13
12-3
12
2/14
G
2/15
Respective Hospital Clinical
Logan, Low
Shock, SIRS, MODS, Sepsis, &
Hemodynamics
Logan
Clinical Day
Respective Hospital Clinical
Carter
EFH
Clinical Day
Respective Hospital Clinical
Logan, Shupak,
Low
2/16
EH
Clinical Day
Respective Hospital Clinical
Logan, Low
2/20
Lab
COC 2
8-10
10-12
COC Day 2
ABCD
EFGH
EKG rhythm interpretation, treatment
and hemodynamics, IV lines & devices
2/20
Rm 101
1-4
18,19
2/21
C
Clinical Day
Acute/Chronic GI Alterations
Endocrine Alterations
Respective Hospital Clinical
2/22
ABD
Clinical Day
Respective Hospital Clinical
2/23
AD
Clinical Day
Respective Hospital Clinical
2/27
Rm 115
2/27
Rm 101
3/1
10-12
Exam
2
1-4
EFG
16,17
Clinical Day
Acute Kidney Alterations & Immunology
Respective Hospital Clinical
Low
Logan, Shupak,
Low
3/2
FGH
Clinical Day
Respective Hospital Clinical
3/6
12-3
13
Logan, Carter,
Low
Logan
3/7
D
Clinical Day
Respective Hospital Clinical
Carter
3/8
ABC
Clinical Day
Respective Hospital Clinical
3/9
BC
Clinical Day
Respective Hospital Clinical
Logan, Shupak,
Low
Logan, Low
3/13-3/17
Break
Spring Break!
Spring Break!!
All
3/20
12-3
13
Cardiac Day 3
Logan
3/21
H
Clinical Day
Respective Hospital Clinical
Carter
3/22
EFH
Clinical Day
Respective Hospital Clinical
Logan, Shupak,
Low
Exam 2 EKG, Neuro, GI/Endo, Shocks,
Hemodynamics
Cardiac Day 2
6
All
Logan
Carter
Logan, Shupak,
Low
Logan, Low
All
NUR 406
Spring 2017
3/22
Last Day to drop course with a W
3/23
FG
Clinical Day
3/27 Rm 115
8-10
Exam 3
3/27 Rm 101
12-4
20, 21
Cardiac Day 2 and 3, Kidney Alterations,
Immunology
Logan, Shupak,
Low
All
Shupak, Carter
Trauma, Burns
Respective Hospital Clinical
3/28
D
3/29
ABC
Clinical Day
Respective Hospital Clinical
3/30
BC
Clinical Day
Respective Hospital Clinical
4/3 Rm 101
12-3
3,4
4/4
Sim lab
4/5
Sim lab
8-12-EF
1-5- GH
8-12-AB
1-5-CD
Clinical
Practice
Clinical
Practice
4/10
12-3
13
4/11
830-330
Simulations
4/12
8301130
Break
Simulations
4/27
Rm 115
8-10
Exam 4
5/1 Rm 101
2-4
HESI Review
5/2
Sign up
5/5 Rm 115
1-3
5/8 Rm 115
1-3
4/13-4/17
Clinical Day
Respective Hospital Clinical
Legal, Ethical, End of Life, Organ Donation
Clinical Practice in Lab, Blood
transfusions, trauma, titration of drips
Clinical Practice in Lab, Blood
transfusions, trauma, titration of drip
Cardiac Day 4
Carter
Logan, Shupak,
Low
Logan, Low
Carter
Carter, Shupak
Carter, Shupak
Logan
Simulations (see additional schedule for
group assigned times)
Simulations (see additional schedule for
group assigned times)
Easter Break!!!
Classes resume 4pm 4/17
Exam 4: Cardiac Day 4, Legal, Ethical,
End of Life, Organ Donation, Blood
transfusions, Trauma and Burns
HESI Review for CC/ Med-Surg
All
All
CC HESI
Clinical Evaluations- sign up with
instructor
CC HESI
MS- HESI
MS- HESI
All
All
All
All
All
All
Clinical Time:
LL=Learning Lab
COC=Clinical on Campus
CP=Clinical Practice (Clinical Scenarios in Lab)
**** LL, COC, CP, and hospital clinical days constitute clinical hours
and attendance is mandatory.
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Hospital Clinical Days
Groups will rotate halfway through clinical
Groups A&E, B&F: WHMC = Lufkin Woodland Heights Medical Center (Logan)
Groups D&H, C&G: Nac Memorial = Nacogdoches Memorial Hospital (Low)
Group C&G, D&H: CHI St. Luke’s Health Memorial Lufkin (Carter)
Group B&F, A&E: CHI St. Luke’s Health Memorial Lufkin (Shupak)
Group
COC
1
COC
2
Hosp
Hosp
Hosp
Hosp
Hosp
Hosp
CP
A
1/25
2/20
1/25
2/20
2/9
WHMC
8
2/22
CHI
12
2/22
WHMC
8
3/8
WHMC
8
2/23
WHMC
8
3/9
WHMC
8
3/8
CHI
12
3/29
WHMC
8
3/29
CHI
12
3/30
WHMC
8
4/5
8-12
B
2/8
WHMC
8
2/8
CHI
12
C
1/25
2/20
1/25
2/20
E
1/25
2/20
F
1/25
2/20
G
1/25
2/20
2/21
CHI
12
2/9
Nac
8
2/2
WHMC
8
2/15
CHI
12
2/14
CHI
12
3/8
Nac
8
2/22
Nac
8
2/15
WHMC
8
3/1
WHMC
8
3/1
Nac
8
3/9
Nac
8
2/23
Nac
8
2/16
CHI
12
3/2
WHMC
8
3/2
Nac
8
3/29
Nac
8
3/7
CHI
12
3/1
CHI
12
3/22
WHMC
8
3/22
Nac
8
3/30
Nac
8
3/28
CHI
12
3/22
WHMC
8
3/23
WHMC
8
3/23
Nac
8
4/5
1-5
D
2/7
CHI
12
2/8
Nac
8
2/1
WHMC
8
2/1
CHI
12
1/31
CHI
12
H
1/25
2/20
3/2
CHI
12
3/21
CHI
12
2/1
2/2
2/15
2/16
Nac
Nac
Nac
Nac
8
8
8
8
Times will be announced for each hospital location.
8
4/5
8-12
4/5
1-5
4/4
8-12
4/4
8-12
4/4
1-5
4/4
1-5
NUR 406
Spring 2017
Grading Policy
Didactic Points
Exam 1
Exam 2
Exam 3
Exam 4
Med/Surg HESI
Critical Care HESI
75 (15%)
75 (15%)
75 (15%)
75 (15%)
75 (15%)
75 (15%)
Quiz average
NCLEX Questions
15 (3 %)
35 (7 %)
Total 500 (100%)
It is necessary to obtain a WEIGHTED MEAN TEST SCORE OF 75 on the class exam
grades to pass this course. A weighted mean test score below 75 or a class average below 75
constitutes failure of Nursing 406 and will result in a grade of “F" on the transcript.
Grades are rounded to the nearest hundredth. (For example: A 74.45 would be passing,
and a 74.44 would be an F.)Clinical will be graded as a Pass/Fail. You must pass both the
class and clinical in order to pass Nursing 406 (Nursing Policy No. 25).
The test analysis form MUST be completed after each course/unit exam if the raw score is less
than 75%. All can complete it, but we need the data from those making less than 75%.
Remediation is also mandatory after each exam if the nullified score is less than 75%.
NOT for HESI exams.
Medical/Surgical HESI Exam
The Medical/Surgical HESI Exam will be taken at the end of the semester. This exam covers
medical/surgical content from both medical/surgical courses. Reviewing patient reviews, case
studies, NCLEX style questions and reviewing previous HESI exam remediation materials will
assist in preparing for this exam.
Critical Care HESI Exam
The Critical Care HESI will be given at the end of the semester. This exam covers all of the
content covered in NUR 406 and will act as the course final exam.
Cell Phone Use
Cell phones will be silenced prior to the beginning of class. Cell phones will only be used for
educational purposes.
Computer Use in the Classroom
Computers are allowed in the classroom for note taking and educational use. Using a computer
for any other activities will not be tolerated and may result in the confiscation of the computer
for the remainder of the class.
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Attendance Policy
Attendance is not mandatory; however, all students are expected to attend classes regularly. An
attendance sheet will be passed around and each student is required to sign it. No student may
sign in another student. If this occurs, both students will be counseled and an F day will be
earned. The sign-up sheet will be taken up at some point in the lecture. Attendance is assessed
and encouraged for the student to be successful in Nursing 406. Attendance is necessary to gain
access to the online quizzes after class.
Academic Integrity (A-9.1)
Academic integrity is a responsibility of all university faculty and students. Faculty members
promote academic integrity in multiple ways including instruction on the components of
academic honesty, as well as abiding by university policy on penalties for cheating and
plagiarism.
Desire to Learn (D2L)
For D2L technical support, contact student support in the Office of Instructional Technology
(OIT) at
[email protected] or 936-468-1919. If you call after regular business hours or on a weekend, please
leave a voicemail.
For general computer support (not related to D2L), contact the Technical Support Center (TSC)
at 936-468-HELP (4357) or at [email protected].
To learn more about using D2L, visit SFA ONLINE at http://sfaonline.sfasu.edu , where you’ll
find written instructions and video tutorials.
Definition of Academic Dishonesty
Definition of Academic Dishonesty
Academic dishonesty includes both cheating and plagiarism. Cheating includes, but is not limited
 to: using or attempting to use unauthorized materials on any class assignment or exam;
 falsifying or inventing of any information, including citations, on an assignment; and/or;
helping or attempting to help another in an act of cheating or plagiarism.
Plagiarism is presenting the words or ideas of another person as if they were one’s own.
Examples of plagiarism include, but are not limited to:
 submitting an assignment as one's own work when it is at least partly the work of another
person;
 submitting a work that has been purchased or otherwise obtained from the Internet or
another source; and/or,
 incorporating the words or ideas of an author into one's paper or presentation without
giving the author credit.Please read the complete policy for further information and
penalties at http://www.sfasu.edu/policies/student_academic_dishonesty.pdf
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Withheld Grades (Semester Grades Policy A-54)
Ordinarily, at the discretion of the instructor of record and with the approval of the academic
chair/director, a grade of WH will be assigned only if the student cannot complete the course
work because of unavoidable circumstances. Students must complete the work within one
calendar year form the end of the semester in which they received a WH, or the grade
automatically becomes an F. If students register for the same course in future terms the WH will
automatically become an F and will be counted as a repeated course for the purposes of
computing the grade point average.
The circumstances precipitating the request must have occurred after the last day in which a
student could withdraw from a course. Students requesting a WH must be passing the course
with a minimum projected grade of C.
Students with Disabilities
To obtain disability related accommodations, alternate formats and/or auxiliary aids, students
with disabilities must contact the Office of Disability Services (ODS), Human Services Building,
and Room 325, 468-3004 / 468-1004 (TDD) as early as possible in the semester. Once verified,
ODS will notify the course instructor and outline the accommodation and/or auxiliary aids to be
provided. Failure to request services in a timely manner may delay your accommodations.
For additional information, go to http://www.sfasu.edu/disabilityservices/
Acceptable Student Behavior
Classroom behavior should not interfere with the instructor’s ability to conduct the class or the
ability of other students to learn from the instructional program (see the Student Conduct Code,
policy D-34.1). Unacceptable or disruptive behavior will not be tolerated. Students who disrupt
the learning environment may be asked to leave class and may be subject to judicial, academic or
other penalties. This prohibition applies to all instructional forums, including electronic,
classroom, labs, discussion groups, field trips, etc. The instructor shall have full discretion over
what behavior is appropriate/inappropriate in the classroom. Students who do not attend class
regularly or who perform poorly on class projects/exams may be referred to the Early Alert
Program. This program provides students with recommendations for resources or other
assistance that is available to help SFA students succeed.
Campus Carry
It is the carrier’s responsibility to know the law concerning campus carries. Refer to
www.sfasu.edu/campuscarry for information.
HIPAA Compliance Requirement Information
Each student is required to sign a HIPAA Compliance Requirement Information Sheet and abide
by the agreement. No exceptions. Failure to comply will result in a “F” day.
Course Grades
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Quizzes (15 points)
Quizzes may be given on D2L either prior to class lecture or after class. They will range from
knowledge based questions that assesses the students preparedness for class to critical thinking
application questions that will prepare the student for the exams. The average of these quizzes
will count as 15 points (3%) of the overall points. This grade will NOT be considered part of the
exam average. Missed quizzes will not be made up for any reason. One attempt is given for
each quiz, and answers will not be posted. No quiz remediation will be done. Quizzes are
password protected and password will be given during class time on the assigned quiz day
or prior to class at instructor discretion. Attendance to class is required to obtain
password for corresponding quiz.
"A Nurse’s Story" (1/17/17)
The student is required to read "A Nurse’s Story" by Tilda Shalof. On completion of the book the
student will complete the assignment found on D2L under the clinical tab. This assignment is
considered part of your quiz average.
This assignment will be submitted in the drop box by 5pm on 1/17/17. Late work not accepted.
Quiz
Syllabus Quiz
Pulmonary Quiz
Drug Calculations Quiz
EKG Quiz
Neurovascular Quiz
Shock/Hemodynamics Quiz
Endocrine Quiz
GI Quiz
Renal Quiz
Trauma/Burns/Organ Donation Quiz
Legal, Ethical, End of Life Quiz
Cardiovascular Quiz
Opens
1/17 1200
1/23 1500
1/25 1700
1/30 1600
2/6 1500
2/13 1500
2/20 1600
2/20 1600
2/27 1600
3/27 1600
4/3 1500
4/10 1500
Due Date
1/17 2359
1/23 2359
1/27 2359
1/30 2359
2/6 2359
2/13 2359
2/20 2359
2/20 2359
2/27 2359
3/27 2359
4/3 2359
4/10 2359
Course NCLEX Questions Adaptive Quizzing Assignments (35 points)
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

For each content area there will be an assignment created on the web site under our
course. You must obtain the assigned mastery level of 2 to receive full credit (100). No
partial credit will be given for a mastery below 2. The instructors will obtain your
grades directly from the website. No papers will be turned in or submitted to D2L.
Each assignment is due by midnight on the assigned date.
Content area
Mastery Level
a. Pulmonary
2
b. Neuro
2
c. GI
2
d. Endocrine
2
e. Renal (GU)
2
f. Cardio
2
g. Infectious Disease 2
Total
Points Received
5
5
5
5
5
5
5
35
Due Date
2/6
2/20
3/6
3/27
4/3
4/10
4/24
Course Evaluations: Course evaluations in Typhon may be completed online towards the end of
the semester. Two points will be added to your final points (NOT an EXAM GRADE) if all
evaluations are completed prior to the Final Exam. This = 0.2 points to the total average. **
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Suggested Learning Activities
The faculty has located learning activities the student may use to broaden and reinforce the
course content. These are not required activities and will not be graded. They are to be used as
intended, to assist the student to succeed in this course as well as on the NCLEX. The student is
responsible for locating useful study aids. Listed are a few of the activities:
1. Evolve RN Patient Reviews and Case Studies
The Evolve RN Patient Reviews and Case Studies are content dense reviews over various disease
processes that will be covered this semester. These reviews and case studies are designed to
assist the student prepare for class each week and review for exams. Students who have used
these to study have seen improved scores on the HESI exams. The faculty suggests the student
make copies of the results of these activities to assist in monitoring their strengths, weaknesses
and progress.
Patient reviews that will be helpful this semester are located on the Evolve site under:
 Adult Health
 Clinical Nursing Concepts
 Critical Care
Case Studies that will be helpful this semester are located on the Evolve site under:
 Basic Care of the Adult Client
 Medical-Surgical
2. Worksheets
Several worksheets may be found on D2L. The worksheets were created because adequate
patient reviews or case studies were not located that covered this material.
3. Evolve Website
HESI- All prior HESI exams can be reviewed for remediation of weaker content areas.
4. Concept mapping
If you find a disease process that is challenging, concept mapping the disease process is an
excellent activity to review the concept.
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Unit Objectives
(These are the unit objectives for the required reading. See previous list for assigned
quizzes and NCLEX questions associated with corresponding content. There are also
Evolve clinical skills associated with the content in these chapters. See additional list for all
assigned topics in evolve. )
Chapter 1 Objectives: Overview of Critical Care Nursing
1. Define critical care nursing.
2. Discuss the purposes and functions of professional organizations that support critical care
practice.
3. Explain certification options for critical care nurses.
4. Describe standards of professional practice for critical care nursing.
5. Describe quality and safety initiatives related to critical care nursing.
6. Identify current trends and issues in critical care nursing.
Chapter 2 Objectives: Patient and Family Response to the Critical Care Experience
1. Describe stressors in the critical care environment and strategies to reduce them.
2. Discuss the impact of critical care hospitalization on the patient and family.
3. Describe common family needs and family-centered nursing interventions.
4. Identify strategies for promoting visitation and family presence in the critical care setting.
Chapter 3 Objectives: Ethical and Legal Issues in Critical Care Nursing
1. Discuss ethical principles and legal concepts related to critical care nursing.
2. Apply the components of a systematic, ethical decision-making model.
3. Discuss legal accountability related to critical thinking.
4. Discuss ethical and legal issues that arise in the critical care setting.
5. Describe elements of negligence and malpractice that may result from nursing practice.
Chapter 4 Objectives: Palliative and End of Life Care
1. Describe ethical and legal concerns related to end-of-life care.
2. Discuss concepts of end-of-life care, including palliative care; communication and conflict
resolution; withholding or withdrawing therapy; and psychological support of the patient, family
members, and healthcare providers.
3. Discuss cultural considerations in end-of-life care.
4. Describe nursing interventions to support the patient and family during the end-of-life stage.
Chapter 5 Objectives: Comfort and Sedation
1. Define pain and anxiety.
2. Identify factors that place the critically ill patient at risk for developing pain and anxiety.
3. Discuss the physiology of pain and anxiety.
4. Describe the positive and negative effects of pain and anxiety in critically ill patients.
Chapter 6 Objectives: Nutritional Therapy
1. Review the anatomy and physiology related to utilization of nutrients.
2. Discuss methods for evaluating nutritional status.
3. Describe interventions to achieve nutritional goals.
4. Discuss practice guidelines related to nutritional support.
5. Describe strategies for monitoring and evaluating the nutrition care plan.
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Chapter 7 Objectives: Dysrhythmia Interpretation and Management
1. Explain the relationships between electrical and mechanical events in the heart.
2. Interpret the basic dysrhythmias generated from the sinoatrial node, the atria, the atrioventricular
node, and the ventricles.
3. Describe appropriate interventions for common dysrhythmias.
4. Explain the basic concepts of cardiac pacing.
Chapter 8 Objectives: Hemodynamic Monitoring
1. Identify normal hemodynamic values.
2. Articulate appropriate nursing actions for patients with altered hemodynamic values.
3. Describe the indications, measurement, complications, and nursing implications associated with
monitoring of invasive right atrial, left atrial, pulmonary artery, and intraarterial pressures and
those equated with noninvasive hemodynamic indices.
4. Identify the physiological basis for hemodynamic monitoring in critically ill patients.
5. Discuss the rationale and methods for continuous monitoring of mixed venous oxygen saturation.
6. Analyze conditions that alter hemodynamic values.
7. Explain the clinical relevance and methods of measuring cardiac output.
Chapter 9 Objectives: Ventilatory Assistance
1. Review the anatomy and physiology of the respiratory system.
2. Describe methods for assessing the respiratory system, including physical assessment,
interpretation of arterial blood gases, and noninvasive techniques.
3. Compare commonly used oxygen delivery devices.
4. Discuss methods for maintaining an open airway.
5. Identify indications for initiation of mechanical ventilation.
6. Describe types and modes of mechanical ventilation.
7. Relate complications associated with mechanical ventilation.
8. Explain methods for weaning patients from mechanical ventilation.
9. Formulate a plan of care for the mechanically ventilated patient.
Chapter 10 Objectives: Rapid Response Team and Code Management
1. Compare roles of caregivers in rapid response teams (RRTs) and managing cardiopulmonary
arrest situations.
2. Identify equipment used during a code.
3. Differentiate basic and advanced life-support measures used during a code.
1. Identify medications used in code management, including use, action, side effects, and nursing
implications.
2. Discuss treatment of special problems that can occur during a code.
3. Describe special concerns related to the geriatric population during a code.
4. Identify information to be documented during a code.
5. Describe care of patients after resuscitation.
6. Identify psychosocial, legal, and ethical issues related to code management.
Chapter 11 Objectives: Organ Donation
1. Discuss processes associated with organ donation.
2. Describe clinical triggers associated with brain death.
3. Discuss components of donor management.
4. Discuss immunosuppression of the solid organ transplant recipient.
5. Describe the postsurgical nursing and medical management of solid organ transplant procedures.
6. Discuss complications associated with the long-term management of solid organ transplant
recipients.
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7. Discuss organ rejection and associated nursing and medical management strategies.
8. Discuss the implications for patient education regarding long-term transplant care.
Chapter 12 Objectives: Shock, Sepsis, Multiple Organ Dysfunction Syndrome
1. Define shock.
2. Describe the continuum of sepsis.
3. Correlate the four classifications of shock to their pathophysiology.
4. Discuss the progression of shock through three stages.
5. Relate assessment findings to the classification and stage of shock.
6. Describe management strategies for each type of shock.
7. Develop an individualized plan of care that includes nursing diagnosis, expected outcomes,
nursing interventions, and rationale.
Chapter 13 Objectives: Cardiovascular Alterations
1. Contrast the pathological cause and effect mechanisms that produce acute cardiac disturbances.
2. Discuss the nursing care responsibilities related to the cardiac and vascular patient.
3. Compare and contrast pharmacological, operative, and electrical treatment modalities used in
treatment of cardiac disease.
4. Identify specific nursing interventions designed to prevent secondary occurrences or to minimize
complications of cardiac and vascular patients.
5. Develop a research-related care plan for the acutely ill cardiovascular patient.
Chapter 14 Objectives: Nervous System Alterations
1. Review the anatomy and physiology of the central nervous system.
2. Describe the pathophysiology of increased intracranial pressure.
3. Describe the nursing and medical management of patients with increased intracranial pressure.
4. Describe the nursing and medical management of patients with skull fractures.
5. Complete an assessment on a critically ill patient with nervous system injury.
6. Describe the pathophysiology of head injury.
7. Describe nursing and medical management of patients with a spinal cord injury.
8. Discuss the nursing assessment and care of a critically ill patient with cerebrovascular disease.
9. Describe the pathophysiology and management for status epilepticus.
Chapter 15 Objectives: Acute Respiratory Failure
1. Describe the pathophysiology, assessment, and management, and plan of care for the patient with
acute respiratory failure, acute lung injury, pneumonia, aspiration pneumonitis, pulmonary
embolism, status asthmaticus, air leak disorders, and thoracic traumatic injuries.
2. Analyze Arterial Blood Gases and discuss causes and treatments for abnormalities.
3. Discuss nursing management of patients undergoing pulmonary diagnostic procedures.
4. Discuss the use of pulse oximetry and capnography for bedside monitoring.
5. Discuss purpose, method and nursing care related to chest tubes.
6. Describe the priorities and postoperative management following lung transplantation.
Chapter 16 Objectives: Acute Kidney Injury
1. Review the anatomy and physiology of the renal system.
2. Describe the pathophysiology and systemic manifestations of acute kidney injury.
3. Describe the methods for assessing the renal system, including physical assessment, and
interpretation of laboratory values and radiological diagnostic tests.
4. Develop a plan of care for the patient with acute kidney injury.
5. Describe the medical management of the patient with acute kidney injury.
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6.
7.
8.
9.
10.
11.
Discuss the nursing care of the patient receiving renal replacement therapy.
Discuss immunosuppression of the solid organ transplant recipient.
Describe the postsurgical nursing and medical management of kidney transplant procedures.
Discuss complications associated with the long-term management of kidney transplant recipients.
Discuss organ rejection and associated nursing and medical management strategies.
Discuss the implications for patient education regarding long-term kidney transplant care.
Chapter 17 Objectives: Hematological and Immune Disorders
1. Explain the normal anatomy and physiology of the hematological and immune systems.
2. Describe pathophysiological changes that affect hematological and immunological structure and
function.
3. Discuss the risk factors, pathophysiological process, clinical findings, nursing care, and medical
management of anemia, neutropenia, malignant white blood cell disorders, human
immunodeficiency virus, thrombocytopenia, and disseminated intravascular coagulation.
4. Develop plans of care for the immunocompromised host and the patient who has a bleeding
disorder.
Chapter 18 Objectives: Gastrointestinal Alterations
1. Review the anatomy and physiology of the gastrointestinal system.
2. Describe general assessment of the gastrointestinal system.
3. Compare the pathophysiology, assessment, nursing diagnoses, outcomes, and interventions for
acute upper gastrointestinal bleeding, acute pancreatitis, and hepatic failure.
4. Formulate a plan of care for the patient with acute upper gastrointestinal bleeding, acute
pancreatitis, or hepatic failure.
5. Describe the postsurgical nursing and medical management of liver transplant procedures.
6. Discuss the implications for patient education regarding long-term kidney transplant care.
Chapter 19 Objectives: Endocrine Alterations
1. Review the anatomy, physiology, and feedback mechanisms for regulation of insulin, cortisol,
thyroid hormones, and antidiuretic hormone.
2. Describe the pathophysiology and systemic manifestations of disorders resulting from alterations
in hormones secreted by the pancreas, adrenal, thyroid, and posterior pituitary glands.
3. Describe the methods for assessing the endocrine system, including physical assessment, and
interpretation of laboratory and other diagnostic tests.
4. Discuss the medical management of patients with hyperglycemic crisis, hypoglycemic crisis,
adrenal crisis, thyroid storm, myxedema coma, diabetes insipidus, and the syndrome of
inappropriate secretion of antidiuretic hormone (SIADH).
5. Formulate plans of care for patients with critical alterations in endocrine function.
Chapter 20 Objectives: Trauma and Surgical Management
1. Describe a systems approach to trauma care.
2. Identify mechanisms of traumatic injury commonly seen in the critical care setting.
3. Discuss prehospital care, emergency care, and resuscitation of the trauma patient.
4. Describe assessment and management of common traumatic injuries.
5. Explain the priorities of care for the postoperative surgical patient.
6. Formulate a plan of care for the trauma patient, including prevention of complications.
Chapter 21 Objectives: Burns
1. Review the anatomy and physiology of the integumentary system.
2. Describe the pathophysiology of burns.
3. Compare the types of burn injuries.
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4. Discuss the primary and secondary survey assessments during resuscitation and the acute phases
of burn management.
5. Formulate a plan of care for the patient with a burn injury.
6. Relate the nursing diagnoses, outcomes, and interventions for the burned patient.
Supplemental: Gerontology Objectives
1. Describe the age-associated physiologic changes that occur in the sensory, cardiovascular,
pulmonary, renal, gastrointestinal, hepatic, integumentary, immune, and neurologic systems.
2. State the clinical significance of age-related physiologic changes and the expected nursing
interventions used in caring for older critical care patients.
3. Relate the age-associated changes in hepatic function and the accompanying pharmacokinetic
changes to the administration of various cardiovascular medications.
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CLINICAL SYLLABUS
Clinical sites:
Nacogdoches Memorial Health
CHI St. Luke’s Memorial Health Lufkin
Woodland Heights Medical Center
See calendar for times and location.
Text and Materials:
Same as for the didactic portion of class.
Clinical Experience
PURPOSE: The purpose of the Clinical practicum is to provide the senior nursing student a 126
hour clinical practicum in order to utilize the nursing process as a framework for practice with
clients requiring intensive nursing care. In addition, the course is designed to facilitate and
improve proficiency in providing nursing interventions; organizational skills required to care for
acutely ill patients', communication skills utilized with clients, families and other health care
professionals to promote optimum well-being; and demonstration of responsibility and
accountability for self-direction, self-evaluation, and for nursing care provided for a group of
patients.
Clinical Hours
Activity
Hospital orientation/computer training
Hospital experience (Hospital clinical time)
ER clinical day with preceptor (Hospital time)
Clinical Practice in Lab (includes prep time)
Learning Lab- Documentation Simulation
Learning labs – EKGs (includes prep time)
Learning lab – clinical information (includes prep time)
Clinical on Campus (includes prep time)
Clinical simulations ( includes pre/post assignments)
Elsevier Clinical Skills videos
Total
20
Clinical Hours
4
56
12
6
2
12
7
12
8
7
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Clinical on Campus (COC)
Each student will complete one 8 hour day in class and one 4 hour day in the simulation lab
practicing nursing and assessment skills needed to care for the complex client in the ICU setting.
(12 hours)
Clinical Practice (CP)
Each student will spend 4 hours in the simulation lab practicing skills needed to assist in the care
of clients in the critical care unit. This will incorporate multiple aspects from classroom and
clinical scenarios. Documentation will be submitted at the instructor discretion. No late work
accepted. (6 hours including prep time)
Clinical Simulations (CS)
Each student will complete 4 complex simulations this semester. (8 hours)
Assignments are due to the dropbox by midnight the day of the simulation. No late work
accepted.
Hospital Orientations
All students are required to complete the online orientations for Nacogdoches Memorial, CHI St.
Luke’s and the Nacogdoches Memorial Hospital restraint PowerPoint. The Completion forms
must be signed and turned in by first day of class. Regardless of clinical site, all forms must be
completed. This also includes computer training necessary for hospital. (1/17/17 by 0800) (4
hours)
Elsevier Clinical Skills Videos
Students will complete assigned work in the evolve Elsevier account including demonstration
videos, reading, and quizzes. (7 hours) See separate schedule for assigned due dates. These
count as clinical time and must be completed.
Emergency Room
Each student will spend one 12 hour day in the emergency room. This is in addition to the 56
hours spent in acute care areas. Assignments will be posted on D2L for this clinical experience.
This will be a precepted clinical day. Hours are from 0700 – 1900. Paperwork, preceptor
agreement form and evaluation are due in the 406 ER box in admin lobby, the Monday
after assigned clinical day by 12:00 noon. No late work accepted. (Name and clinical group
must be on paperwork.)
Hospital Clinical Days
Students will attend 4- 8 hour clinical days, and 2-12 hour clinical days in the assigned hospital
ICU/step down area. (56 hours total). Documentation will be submitted on paper in a binder, and
turned in to the appropriate box in the administration lobby. All work is due prior to the first
class or exam scheduled on Friday morning. For example: if 408 has class at 8:30, binder should
be submitted no later than 8:30. No late work is accepted.
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Clinical Learning Outcomes
1. Assess clients with complex health needs using inspection, palpation, percussion, and
auscultation, as well as advanced assessment equipment (i.e. hemodynamic monitoring, cardiac
monitors, arterial lines, etc.)
2. Establish nursing diagnosis for clients with complex health needs based on information gained
in client assessment.
3. Plan and implement appropriate nursing care for clients with complex health needs.
4. Evaluate nursing care of clients with complex health needs.
5. Modify the plan of care based on evaluation results.
6. Document care in organized clearly stated fashion on paper and electronically.
7. Formulate accurate and concise shift report.
8. Demonstrate understanding of proper use of simple to sophisticated client care equipment.
9. Administer medications according to the 8 rights.
10. Demonstrate understanding of medications, their interactions, and side effects.
11. Utilize national standards when delivering nursing care for clients with complex health
needs.
12. Identify legal and ethical issues that arise in the care of clients with complex health needs.
13. Apply appropriate research findings to clinical practice.
14. Develop and implement client education based on learning needs assessment.
Learning Lab Objectives:
1. Explain the important electrocardiographic findings, clinical significance, and nursing actions
for each of the cardiac rhythms found in the following classes of dysrhythmias: sinus, atrial,
junctional, ventricular, and all heart blocks.
2. Describe the significance of arterial blood gas values and the oxyhemoglobin dissociation
curve in relation to respiratory function.
3. Interpret arterial blood gases, describing the pathophysiology, clinical manifestations, and
nursing and collaborative management.
4. Demonstrate sterile technique while caring for and changing dressings of various types of
central venous lines.
5. Demonstrate the appropriate techniques needed to:
a. access various central venous lines
b. draw blood from the lines
c. flush the lines to maintain patency
6. Describe nursing assessment and management of a client receiving oxygen therapy.
7. List the indications for, complications of, and nursing management of artificial airways.
8. Differentiate the indications for and modes of mechanical ventilation.
9. Apply the nursing process to the client receiving mechanical ventilation including assessment,
planning, nursing diagnosis, intervention and evaluation.
10. Apply the nursing process to the client with chest tubes including assessment, planning,
nursing diagnosis, intervention and evaluation.
11. Demonstrate endotracheal, tracheal and nasopharyngeal suctioning using sterile technique by
both the closed in-line suction apparatus and the open technique.
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12. Demonstrate the calculations needed to administer the correct doses off all pertinent critical
care medications.
13. Discuss nursing care and interventions appropriate for blood product administration.
Learning Lab Topic Outline:
Cardiac rhythm strip interpretation and treatment
Blood administration
Practice treating life threatening cardiac rhythms (putting it all together)
Critical care drug calculations
Pain and Sedation in the critical care units
Clinical on Campus Topic Outline:
Day One: 1/25
8-12; 1-5 Lecture with all students together in large class room
Pain, Sedation, Delirium
Critical Care Medications
Drug Calculations (IV titration)
-Assessment and documentation
-Concept Mapping
-Hospital Orientations
Day Two: 2/20
Groups A-D 8-10 Rotate through EKG/hemodynamic station/IV lines and devices
Groups E-H 10-12 Rotate through EKG/hemodynamic stations/IV lines and devices
The stations will cover hemodynamics, EKG interpretation, IV lines and devices and critical care
medications.
Evaluation - Clinical Component
Purpose: The purpose of the clinical evaluation process utilized in NUR 406 provides a method
of determining whether desired outcomes have been successfully achieved by the student and to
determine whether the student has sufficient knowledge for the established level of clinical
practice. Clinical practicum evaluation will be focused on both the progress through the clinical
practicum (in learning and practicing new knowledge and skills) and on past learning knowledge
and skills
Method of evaluation: Daily clinical evaluations, final evaluations, counseling conferences,
clinical skills evaluation, nursing assessments and oral nursing processes and clinical concept
maps.
Clinical performance will be evaluated using the clinical evaluation forms found on line.
Absence from Clinical Policy:
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Attendance is mandatory for all clinical hours. To be an excused absence the student must be
excused directly by the clinical instructor. The only excused absence is one related to illness of
self, or death of immediate family member, or significant other. The student must bring a written
excuse by the health provider or an obituary/funeral notice/program.
Absence from the clinical area exceeding 10% will result in a clinical failure regardless of the
reasons (including excused absences). Refer to Policy # 21 in the student handbook.
Any clinical time missed will be made up regardless of reason for absence.
ALL CLINICAL ON CAMPUS, LEARNING LABS, CLINICAL PRACTICE DAYS, AND
SIMULATIONS ARE CONSIDERED CLINICAL TIME AND IS SUBJECT TO THE
SAME ABSENCE POLICIES AS HOSPITAL CLINICALS. FAILURE TO CALL YOUR
CLINICAL INSTRUCTOR PRIOR TO THE START OF THE CLINICAL ACTIVITY IS
CONSIDERED FAILURE TO CALL/FAILURE TO SHOWAND AN “F” DAY WILL BE
RECEIVED.
ALL CLINICAL WILL BE MADE UP. IF A STUDENT MISSES A CLINICAL DAY,
EITHER AN ALTERANATIVE CLINIAL DAY WILL BE ASSIGNED OR AN
ALTERNATIRE ASSIGNMENT WILL BE GIVEN. THIS DECISION IS MADE BY
THE 406 TEAM AND WILL BE COMMUNICATED TO THE STUDENT WITH A
COUNSELING FORM OR F DAY FORM, WHICH EVER IS FOUND TO BE IN THE
JUDGEMENT OF THE FACULTY.
Requirements for passing clinical:
To receive a satisfactory clinical grade, the nursing student must:
1. Adhere to the policies stated in the student handbook.
2. Obtain a ‘satisfactory’ on all criteria found on the clinical evaluation.
3. Give a satisfactory demonstration of all selected clinical skills.
4. Give satisfactory performance in all oral or written process recordings and complete all
prescribed remediation.
Clinical Grading Rubric
In order to pass this course, you must also pass clinically. You must receive 42 out of a possible
50 points to pass. Point will be deducted for the following:
1. Arriving late to clinical site (includes hospital clinical, clinical on campus, learning lab,
clinical practice, and simulations).
2. Any clinical assignment/paperwork submitted incomplete. (no late work will be accepted
and will result in full points deducted)
3. Hospital orientation(s) paperwork not submitted by the due date or submitted incomplete
by due date.
4. Your preceptor agreement must be completed- correctly and submitted as directed. (see
preceptor agreement information)
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5. You preceptor evaluations must be completed and submitted as directed. (See preceptor
agreement information).
Breakdown of Points
Clinical Days
Clinical Documentation
Hospital Orientation
Preceptor Agreement/Evaluation
Simulation
Simulation Pre/Post Assignments
Clinical on Campus 1 & 2
Clinical Practice
Learning Labs
Documentation Lab
Total Possible Points
12
12
2
2
4
4
4
4
4
2
50
ALL clinical documentation is required by due date assigned or an F day will be received.
Students may not receive more than 2 clinical "F" days and receive a passing grade in the
course.
Post Conference: Post conference for the clinical practicum will be held at least once weekly.
Students are expected to organize their care so that they can attend post conference on time on
the clinical days as scheduled. The student will give an updated report on each assigned patient
to the Nurse before leaving the floor. The report should include:
1. Client's name, room number, age, physician, date of admission, diagnosis, date and type of
surgical procedure.
2. Diet, scheduled snacks, and any assistance required in feeding, amount of diet taken during the
shift and tolerance, any special notations (i.e., NPO at midnight for tests or surgery (NG tube to
low suction, etc.).
3. Prescribed activity, activity during shift and tolerance.
4. Orders for intake and/or output and amounts for the shift; whether the patient has had a stool
during the shift.
5. Vital sign frequency and/or special instructions (i.e., neuro checks, CMS checks) and pertinent
changes in these parameters.
6. Amount, route and frequency of oxygen administration, special considerations such as
suctioning requirements.
7. Current treatments to be done by the oncoming shift and pertinent information related to the
treatments.
8. Scheduled studies for the next two shifts. Scheduled studies completed on your shift and any
results.
9. General condition and special needs.
10. Specific changes over the last 12 hours.
11. Problems or potential difficulties.
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12. Significant medications or IV therapy, i.e., reactions, blood administration, anticoagulant
therapy, sliding scale insulin, titrated drips, chemotherapy.
13. Pending discharges and/or transfer.
14. Any relevant information essential to proper care of the patient.
Medication Administration
The student will follow the institutions medication administration policies. The student must
access two patient identifiers for example by checking the clients arm band and asking the
client his/her name and birth date prior to all medication administration.
Students are to properly document medication administration following hospital policy. Students
are expected to know the indications for, dose, and side effects to observe for prior to
administration of any drug.
Should an error in medication occur, the instructor should be notified immediately and the
proper documentation forms initiated. The decision to give an F Day is left to the discretion
of the clinical instructor.
The nurse or clinical instructor must accompany the student during all medication
administration.
ALL MEDICATIONS REQUIRING CALCULATIONS (INCLUDING TITRATED IV
MEDICATIONS) MUST BE VERIFIED BY THE INSTRUCTOR OR THE PATIENT’S
PRIMARY NURSE PRIOR TO ADMINISTRATION.
Critical care medications: the student is required to check the calculations of all continuous IV
medications that are hanging on their patients (dopamine, lidocaine, dobutamine, inocor, heparin,
morphine, ativan, propofol, etc.). These calculations will be written down and checked by the
instructor by 0800 each clinical day.
The Clinical Concept Map
A written Clinical Concept Map will be given to the instructor for all assigned patients. There is
no "right" way to draw the map. The purpose of the map is to describe the relationships between
the patient's problems, signs and symptoms, therapies, and nursing diagnosis or problems. It will
be evaluated on a pass/fail basis depending on the completeness of the map as well as the
student's ability to verbally explain the map. The map will be reviewed with the instructor each
day of clinical by 10am. Failure to complete the map or adequately defend it will result in the
student receiving an "F" day and being pulled off of patient care activities for that day.
Concept Map Guidelines
1. Map out the pathophysiology of the disease. (Orange)
a. Be very detailed.
b. Place one concept or step of the pathology in each box.
c. Label the connections
2. List all of the risk factors or potential causes of the disease. (One in each box) (Pink)
a. Connect to pathophysiology.
b. Label the connections
3. Place all of the signs/symptoms, lab values, vital signs, diagnostic test findings, etc. in the map
connected to the appropriate pathology. (Yellow)
a. Label the connections
4. Identify appropriate Nursing Diagnosis and connect to the signs/symptoms, etc. (Purple)
a. Label the connections
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5. Place all suggested treatments in the map with connections to either signs/symptoms, vital
signs, diagnostic test findings, or pathology. (Green)
a. Label the connections
6. Reference location of pathophysiology from text
When discussing the plan of care with your instructor you need to be able to explain the
following:
a. Why was each nursing diagnosis selected?
b. What are the priority nursing diagnoses/problems?
c. What are the priority nursing actions?
d. What conclusions did you draw from lab and diagnostic tests?
1. Why were the tests ordered?
2. What do the tests indicate?
3. Is any nursing action needed?
e. How appropriate is the stated outcome for your patient?
f. How will the interventions aid in achieving the desired patient outcome?
g. Are the expected outcomes for your patient being achieved through nursing and
medical intervention?
1. Were the daily outcomes met?
2. Have the nursing interventions been effective?
3. Are revisions needed in the outcomes or nursing interventions?
4. What has been the therapeutic effect of medications and treatments for
your patient?
5. Has your patient experienced any side effects? If so, is any nursing action
needed.
Clinical Portfolio
The clinical portfolio is the notebook you will be required to carry during your N-406 clinical
experiences. You will bring the complete portfolio to the first COC day so that we can go
over documentation and forms at that time, it is not turned in. The notebook must meet the
following requirements:
a. Outside:
i. Blue binder (the one from 2nd semester will work)
ii. One inch or ½ inch binder
iii. Name, course title, and clinical group number
b. Inside:
The first page of the notebook will be a current (this semester) photo of the student (not a group
shot!), in SON scrubs by 1st clinical day.
i. Divider Sections
1. Clinical Documentation (Most recent documentation goes on front)
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a.) Concept map
b.)Daily drug calculations/EKG sheet.
c.) Daily clinical assessment/medication/lab/vitals flow sheets
d.) ER documentation (To be turned in with preceptor eval to the 406 ER bin in admin lobby)
e.) No patient identifiers please! (This is a HIPPA violation and will result in an F Day.
2. Evaluations
a.) Clinical Points Sheet
b.) Evaluation sheet
c.) Final clinical evaluation
d.) ER evaluation and ER preceptor agreement form
e.) Clinical Skills Check list (Keep this updated through clinical)
3. Extra form; clinical helps, etc.
a.) Documentation packet
b.) EKG rhythm sheets
c.) Drug calculation sheets
d.) SBAR form
e.) Alternate clinical experience worksheet
** The forms (evaluations, charting, exercises, etc.) are located on the N-406 D2L course
website.
 Clinical work will be checked throughout day for progress/comprehension.
 Clinical work will be submitted to the admin lobby in the appropriate box, prior to first
class or exam on Friday am following the assigned clinical day.
 (Unless cleared by your instructor beforehand, work turned in after that time will result
in a clinical F day!)***
 A sample portfolio will be available in class.
Clinical Guidelines: All groups (Low & Logan- 8 hours, Carter & Shupak- 12 hours)
1.) The morning of the assigned ICU clinical day the student will be expected to arrive at a specified
time to the hospital to collect the assigned patient’s data.
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2.) By 0800 each clinical day the student will have calculated all of the patient’s critical care drips.
The faculty will check each calculation at this time.
3.) On each clinical morning the student will present and be able to defend a completed concept
map for the ICU patient.
4.) At the end of the ICU/Step down day the student will complete:
a. Critical care documentation flowsheet (Clinical binder)
b. Drug calculations (Clinical binder)
c. EKG rhythm strips (Clinical binder)
d. Concept map (Clinical binder)
e. Daily clinical evaluation (Clinical binder)
5.) Post conference will be at clinical instructor discretion
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Stephen F. Austin State University
Richard and Lucille DeWitt School of Nursing
Clinical Evaluation Tool
NUR 406: Nursing Care of Clients with Complex Health Needs
Student: ____________________________Date Fall/Spring: __________
Instructor(s): __________________________________________________
Evaluation Criteria: S = Satisfactory U= Unsatisfactory
Ongoing clinical feedback will be provided in individual student-faculty conferences
throughout the clinical rotation and will be documented on page 3.
Clinical objectives for evaluation are listed on page 2.
By the end of the clinical rotation, the student must Final Comments
satisfactorily demonstrate all behaviors described
in the clinical objectives to pass the clinical portion
of the course. Final Clinical Grade:
(Pass or Fail)
Instructor Signature:
______________________________________
Student Signature:
______________________________________
Date: ____________________
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Stephen F. Austin State University
Richard and Lucille DeWitt School of Nursing
Clinical Evaluation Tool
NUR 406: Nursing Care of Clients with Complex Health Needs
Clinical Objectives
Clinical Outcomes
The student will:
A. MEMBER OF THE PROFESSION
1. Adhere to legal and ethical standards of the profession
in multiple health care settings.
(Includes BON, University, Facility, Code of Ethics,
Standards of Practice, HIPAA, etc.)
2. Assume responsibility and accountability for quality
of nursing care.
DEC
B. CONT.
IA
IIIA
IIIE
IB
4. Assess own strengths and weaknesses and utilize
feedback for professional growth.
5. Arrive on time and maintains appropriate clinical
attendance.
6. Present to clinical setting in a manner that encourages
professional respect.
7. Protect confidentiality of clients, families, and the
facility.
ID
IA
IA
IA
B. PROVIDER OF PATIENT-CENTERED CARE
1. Apply knowledge of the physical, social, and
behavioral sciences in the provision of nursing care
based on theory, research, and evidence based practice.
2. Perform comprehensive assessment to include factors
impacting heath status and health needs of clients with
complex health needs.
3. Utilize nursing process in provision of care to clients
with complex health needs.
4. Design, implement, and evaluate comprehensive
teaching plan for promotion, maintenance, and
restoration of health.
IIA
IIB
IIC
IIB
IIG
5. Perform skills safely and efficiently.
(with supervision or independently as appropriate)
IIID
6. Implement complex nursing care integrating the use
of advanced diagnostic and therapeutic equipment.
IIF
IIH
7. Manage care based on rapidly changing priorities.
IIF
8. Communicate therapeutically maintaining
professional boundaries.
IIE
9. Document care in organized clearly stated fashion.
IIF
31
DEC
10. Complete accurate detailed correlation maps
for each client.
11. Provide health care that is sensitive to and
consistent with cultural values, beliefs, and
customs of the client with complex health needs.
12. Evaluate legal and ethical issues that arise in
the care of clients with complex health needs.
IIC
IIA
IID
IIE
C. PATIENT SAFETY ADVOCATE
1. Maintain strict infection control measures in
clinical settings.
2. Administer medications according to the 8
rights.
3. Determine effects of medications, their
interactions, and side effects.
4. Maintain safety of client by identifying at risk
clients and intervening appropriately.
5. Ensure appropriate and safe use of equipment
in performing client care procedures and
treatments.
6. Teach client and families about the safe use of
equipment needed for healthcare.
IIIB
IIID
IIID
IIIB
IIIC
IIIB
IIID
IIIB
D. MEMBER OF THE HEALTH CARE
TEAM
1. Collaborate with clients and interdisciplinary
health care team (IDHCT) for the planning and
delivery of care.
2. Refer clients to resources that facilitate
continuity of care.
3. Establish effective working relationship with
clients, faculty, staff & peers
4. Formulate verbal/written reports for members
of the interdisciplinary team for their use in
caring for the client over time.
5. Function as a client advocate.
IVA
IVC
IVD
IVD
IVE
IVB